Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Biol Blood Marrow Transplant. 2018 Feb;24(2):393-399. doi: 10.1016/j.bbmt.2017.10.009. Epub 2017 Oct 12.
Chronic graft-versus host disease (GVHD) is a chronic and disabling complication after hematopoietic cell transplantation (HCT). It is important to understand the association of socioeconomic status (SES) with health outcomes in patients with chronic GVHD because of the impaired physical health and dependence on intensive and prolonged health care utilization needs in these patients. We evaluated the association of SES with survival and quality of life (QOL) in a cohort of 421 patients with chronic GVHD enrolled on the Chronic GVHD Consortium Improving Outcomes Assessment study. Income, education, marital status, and work status were analyzed to determine the associations with patient-reported outcomes at the time of enrollment, nonrelapse mortality (NRM), and overall mortality. Higher income (P = .004), ability to work (P < .001), and having a partner (P = .021) were associated with better mean Lee chronic GVHD symptom scores. Higher income (P = .048), educational level (P = .044), and ability to work (P < .001) also were significantly associated with better QOL and improved activity. In multivariable models, higher income and ability to return to work were both significantly associated with better chronic GVHD Lee symptom scores, but income was not associated with activity level, QOL, or physical/mental functioning. The inability to return to work (hazard ratio, 1.82; P = .019) was associated with worse overall mortality, whereas none of the SES indicators were associated with NRM. Income, race, and education did not have statistically significant associations with survival. In summary, we did not observe an association between SES variables and survival or NRM in patients with chronic GVHD, although we found some association with patient-reported outcomes, such as symptom burden. Higher income status was associated with less severe chronic GVHD symptoms. More research is needed to understand the psychosocial, biological, and environmental factors that mediate this association of SES with major HCT outcomes.
慢性移植物抗宿主病（GVHD）是造血细胞移植（HCT）后的一种慢性和致残性并发症。了解社会经济地位（SES）与慢性 GVHD 患者健康结果之间的关联非常重要，因为这些患者的身体健康受损，需要依赖密集和长期的医疗保健利用。我们评估了 SES 与慢性 GVHD 队列中 421 名患者的生存和生活质量（QOL）之间的关联，这些患者参加了慢性 GVHD 联盟改善评估研究。收入、教育、婚姻状况和工作状况进行了分析，以确定与患者在入组时报告的结果、非复发死亡率（NRM）和总死亡率的关系。较高的收入（P = .004）、工作能力（P < .001）和有伴侣（P = .021）与平均 Lee 慢性 GVHD 症状评分较高相关。较高的收入（P = .048）、教育水平（P = .044）和工作能力（P < .001）也与较好的 QOL 和活动能力显著相关。在多变量模型中，较高的收入和恢复工作的能力与 Lee 慢性 GVHD 症状评分的改善均显著相关，但收入与活动水平、QOL 或身体/精神功能无关。无法恢复工作（危险比，1.82；P = .019）与较差的总死亡率相关，而 SES 指标均与 NRM 无关。收入、种族和教育与生存无统计学显著关联。总之，我们没有观察到 SES 变量与慢性 GVHD 患者的生存或 NRM 之间存在关联，尽管我们发现一些与患者报告的结果有关，如症状负担。较高的收入状况与慢性 GVHD 症状较轻有关。需要更多的研究来了解 SES 与主要 HCT 结果相关的社会心理、生物和环境因素。
